Using Structural Equation Modeling to Examine Pathways Between Environmental Characteristics and Perceived Restorativeness on Public Rooftop Gardens in China.

As a kind of informal green space more closely related to the built environment, public rooftop gardens (PRGs) are novel green open space and important salutogenic resource for urban residents. It is one of the most easily accessible method for urban residents to be in contact with outdoor or natural elements from the context of high-altitude living. Given its potential health benefits to city dwellers, existing empirical studies are heavily focused on immediate recovery through visually accessing PRGs (through windows), neglecting the possibility of using PRGs physically as a place of interaction. This paper hypothesizes usage patterns will mediate the associations between the environmental characteristics of PRG and users' restoration. This is done through inputting data from 12 typical samples of PRG in Chengdu, China into structural equation model (SEM). Combining the concept of Perceived Sensory Dimensions (PSD) and Perceived Restorativeness Scales (PRS) with the usage patterns of the above samples, this study aims to examine the correlation of environmental characteristics, usage pattern and restoration, in which identify their relative importance in the context of PRGs. Through serials of numerical tests on the model, the study shows that out of the 20 theoretical pathways constructed by the environmental characteristics (x)-usage patterns (m)-restorative effect (y), only 14 forms a significant correlation. In addition, out of all PSDs, social, serene, refuge, space and nature dimensions are induced into restorative effects through four patterns of use: retreat, nature touch, interpersonal interaction and family-bonding activities. The findings also show that social and family-bonding are the most influential independent and mediating variables respectively in achieving restorative effects in the PRG. This study reveals important findings about how usage patterns mediate the association between the PSD and PRS of users. And it also has generated practical implications on how we can design public rooftop gardens from the perspective of restoration, which could potentially be the key to the future survival and development of PRGs in urban environments.

Pleural fluid secondary to pulmonary cryptococcal infection: a case report and review of the literature.

BACKGROUND: Pulmonary Cryptococcosis (PC) is diagnosed with increasing incidence in recent years, but it does not commonly involve the pleural space. Here, we report a HIV-negative case with advanced stage IIIB non-small cell lung cancer (NSCLC) treated with radiation therapy presented with dyspnea, a new PET-positive lung mass and bilateral pleural effusion suspecting progressive cancer. However, the patient has been diagnosed as pulmonary cryptococcal infection and successfully treated with oral fluconazole therapy. CASE PRESENTATION: A 77-year-old male with advanced stage non-small cell lung cancer treated with combined chemo-radiation therapy who presented with progressive dyspnea, a new PET-positive left lower lobe lung mass and bilateral pleural effusions. Initial diagnostic thoracentesis and bronchoscopy yielded no cancer, but instead found yeast forms consistent with cryptococcal organisms in the transbronchial biopsies of the left lower lobe lung mass. Subsequent to this, the previously collected pleural fluid culture showed growth of Cryptococcus neoformans. The same sample of pleural effusion was tested and was found to be positive for crytococcal antigen (CrAg) by a lateral flow assay (LFA). The patient has been treated with oral fluconazole therapy resulting in gradual resolution of the nodular infiltrates. CONCLUSION: PC should be considered in immunosuppressed cancer patients. Additionally, concomitant pleural involvement in pulmonary cryptococcal infections may occur. The incidence of false positive 18FDG-PET scans in granulomatous infections and the use of CrAg testing in pleural fluid to aid in diagnosis are reviewed.

The research about microscopic structure of emulsion membrane in O/W emulsion by NMR and its influence to emulsion stability.

PURPOSE: This paper discussed the influence of microstructure of emulsion membrane on O/W emulsion stability. METHODS: O/W emulsions were emulsified with equal dosage of egg yolk lecithin and increasing dosage of co-emulsifier (oleic acid or HS15). The average particle size and centrifugal stability constant of emulsion, as well as interfacial tension between oil and water phase were determined. The microstructure of emulsion membrane had been studied by (1)H/(13)C NMR, meanwhile the emulsion droplets were visually presented with TEM and IFM. RESULTS: With increasing dosage of co-emulsifier, emulsions showed two stable states, under which the signal intensity of characteristic group (orient to lipophilic core) of egg yolk lecithin disappeared in NMR of emulsions, but that (orient to aqueous phase) of co-emulsifiers only had some reduction at the second stable state. At the two stable states, the emulsion membranes were neater in TEM and emulsion droplets were rounder in IFM. Furthermore, the average particle size of emulsions at the second stable state was bigger than that at the first stable state. CONCLUSIONS: Egg yolk lecithin and co-emulsifier respectively arranged into monolayer and bilayer emulsion membrane at the two stable states. The microstructure of emulsion membrane was related to the stability of emulsion.

Shifted focus of bronchoalveolar lavage in patients with suspected thoracic malignancy: an analysis of 224 patients.

BACKGROUND: Bronchoscopies are extensively adopted for diagnosing and staging thoracic malignancies, but studies are missing as how to keep the process streamlined and more efficient. To evaluate current role of bronchoalveolar lavage (BAL) for cancer and possible infection diagnosis when practicing comprehensive bronchoscopy for patients suspected with thoracic malignancy, and provide foundation for possible practice modification. METHODS: We retrospectively analyzed a prospectively kept database of immunocompetent patients undergoing bronchoscopy for suspected non-hematologic malignancies. Clinical, radiographic data, bronchoscopic sampling techniques and diagnostic results were recorded. Initially undiagnostic patients were followed up for 2 years for a definitive diagnosis. RESULTS: Of 224 patients included, 179 (79.9%) were confirmed with active thoracic malignancies. BAL diagnostic yield of cancer based on different radiographic characters of target lesion are as follow: isolated lymphadenopathies 0%, central lesions 45.5%, peripheral masses (diameter ≥3 cm) 21.4%, peripheral large nodules (2≤ diameter <3 cm) 15.8%, and peripheral small nodules (diameter <2 cm) 7.1%, while composite bronchoscopy achieved diagnostic yield of 93.3%, 95.5%, 91.7%, 76.9%, and 66.7% in corresponding lesion types. No cancer was diagnosed solely by BAL-cytology. Proportions of patients with positive BAL culture did not differ significantly between patients with and without pre-test suspicion for infections (P=0.199). In multivariable analysis, infections were associated with age ≥75 (OR 3.0; 95% CI: 1.29-7.06), chronic obstructive pulmonary disease (COPD) (OR 2.7; 95% CI: 1.14-6.26) and diabetes mellitus (DM) (OR 4.5; 95% CI: 1.90-10.44). CONCLUSIONS: Omitting BAL cytology in settings of comprehensive bronchoscopy may not compromise cancer diagnosis. For patients primarily suspected with thoracic malignancy, performing BAL culture only based on clinical suspicion could miss important infectious etiology.

A two-dimensional assessment of selected medical websites.

Two major dimensions are commonly used for assessing the breadth and depth of the information content in medical websites. The first dimension deals with quality characteristics consisting of authorship, attribution, confidentiality, currency, disclosure, legitimacy and purpose. Functional variables such as access to medical libraries, reference books, health organisations, information sites, guidelines and reviews, clinical trial sites, drug questions, locating an expert and alternative medicine make up the second dimension. The trend is toward the use of both dimensions for evaluating medical websites. This study examines the breadth and depth of the medical information in the websites of the top 51 medical schools in the USA. The results of this study indicate that there are certain quality-standard measures that are present in all medical websites. However, there are also clear distinctions in quality as well as functional attributes that separate the higher-ranked medical schools from the lower ones. Medical professionals, computer system developers, and end-users of medical information will find the results of this study useful.